J9264
HCPCS Procedure Code
HCPCS code J9264 is the #1,451 most-billed Medicaid procedure code, with $22.9M in payments across 12K claims from 2018–2024. The national median cost per claim is $941.67. Costs vary widely — the 90th percentile is $3,929.00 per claim, 4.2× the median.
Total Paid
$22.9M
0.00% of all spending
Total Claims
12K
Providers
19
Avg Cost/Claim
$2K
National Cost Distribution
How much do providers bill per claim for J9264? Based on 18 providers billing this code nationally.
Median
$941.67
Average
$1,670.98
Std Dev
$2,034.31
Max
$6,957.43
Percentile Distribution (Cost per Claim)
50% of providers bill between $489.88 and $1,741.40 per claim for this code.
90% bill between $304.81 and $3,929.00.
Top 1% bill above $6,939.36.
About This Procedure
HCPCS code J9264 was billed by 19 providers across 12K claims, totaling $22.9M in Medicaid payments from 2018–2024. This code was used for 4K unique beneficiaries.
Fraud Risk Context
Injectable drug codes carry high per-claim costs and have been involved in drug diversion and upcoding schemes.
Source: HHS OIG Reports
Risk Assessment
Billing Statistics
Median Cost/Claim
$941.67
Providers Billing
18
National Spending
$22.9M
Avg/Median Ratio
1.77×
Moderately skewed
Top Providers Billing This Code
Ranked by total Medicaid payments for J9264
| # | Provider | Total Paid |
|---|---|---|
| 1 | 1447539374 | $17.4M |
| 2 | Alivia Specialty Llc Guaynabo, PR · Pharmacy Specialty Pharmacy | $1.5M |
| 3 | Yale New Haven Hospital New Haven, CT · General Acute Care Hospital | $1.3M |
| 4 | Memorial Hospital For Cancer And Allied Diseases New York, NY · Pharmacy | $1.3M |
| 5 | City Of Hope National Medical Center Duarte, CA · General Acute Care Hospital | $241K |
| 6 | Upmc Magee-womens Hospital Pittsburgh, PA · General Acute Care Hospital | $239K |
| 7 | Long Island Jewish Medical Center New Hyde Park, NY · General Acute Care Hospital | $130K |
| 8 | Montefiore Medical Center Bronx, NY · General Acute Care Hospital | $125K |
| 9 | Dana-farber Cancer Institute, Inc. Boston, MA · General Acute Care Hospital | $123K |
| 10 | 1205819729 | $111K |
| 11 | 1770690695 | $100K |
| 12 | 1164493847 | $92K |
| 13 | 1437230034 | $71K |
| 14 | The Cleveland Clinic Foundation Cleveland, OH · General Acute Care Hospital | $49K |
| 15 | 1679660617 | $28K |
| 16 | University Of California Irvine Orange, CA · General Acute Care Hospital | $22K |
| 17 | County Of Ventura Ventura, CA · Clinic/Center, Emergency Care | $18K |
| 18 | 1083661607 | $11K |
| 19 | 1699986331 | $0 |
Showing top 19 of 19 providers billing this code